2 Submit Applications Using This Template.docx

NOFO # 693JK321NF0001

[Insert Your Organization Name Here] State Damage Prevention (SDP) Grant Word Template

Use this template to fill out the required text elements of your application as outlined in the Notice of Funding Opportunity (NOFO) announcement Section D.2.

1. Complete page 2. This page must include your organization name and an authorized signature.

2. Project Abstract/Statement of Objectives is required (you may copy/paste from another document or type directly into the space provided). Applicants may submit an application for more than one project but should select one Element per project. If a project fits into more than one Element, the applicant should select the Element that most closely aligns with the project.

3. You must address all nine elements. There are 5 sections for each element – sections 1 and 2 are required, but sections 3,4 and 5 are required *only* if your proposal addresses that element. (You may copy/paste from another document or type directly into the space provided.)

4. You must complete the Legislative/Regulatory Actions section (you may copy/paste from another document or type directly into the space provided).

5. You must attach this document to your Grants.gov forms package.

6. You must submit a signed copy of your application electronically through Grants.gov

2021 State Damage Prevention Grant Application

The ____ {your organization name} __________hereby applies to the Department of Transportation for Federal funds appropriated for the support of Programs established under 49 U.S.C. Section 60134 et seq.

The state agency plans to carry out the Program, during fiscal year 2021, as described in the "Project Abstract/Statement of Objectives". To accomplish the program, the state agency proposes to expend funds as set forth in the "State Damage Prevention Estimated Budget."

Authorized Signature:____________________________

Title:_____________________________________

Date:_____________________________________

Please print, sign, scan, and submit in Grants.gov

Project Abstract/Statement of Objectives

Please provide a clear and concise description of the work this grant will fund for fiscal year 2021. NOTE: Applicants may submit an application for more than one project but should select one Element per project. If a project fits into more than one Element, the applicant should select the Element that most closely aligns with the project.

{type or insert your Project Abstract here}

ELEMENT 1 - EFFECTIVE COMMUNICATIONS

"Participation by operators, excavators, and other stakeholders in the development and implementation of methods for establishing and maintaining effective communications between stakeholders from receipt of an excavation notification until successful completion of the excavation, as appropriate."

1.1 Does the proposed project address this element? (Required – Yes or No)

1.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

1.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

(see map here: https://www.transportation.gov/opportunity-zones/opportunity-zones-interactive-map )

1.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

1.5 Estimated budget for this element: (Required only if proposal addresses this element)

1.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

· If you need more space you are not limited to just the space below.

ELEMENT 2 – COMPREHENSIVE STAKEHOLDER SUPPORT

"A process for fostering and ensuring the support and partnership of stakeholders, including excavators, operators, locators, designers, and local government in all phases of the program."

2.1 Does the proposed project address this element? (Required – Yes or No)

2.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

2.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

2.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

2.5 Estimated budget for this element: (Required only if proposal addresses this element)

2.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 3 – OPERATOR INTERNAL PERFORMANCE MEASUREMENT

"A process for reviewing the adequacy of a pipeline operator's internal performance measures regarding persons performing locating services and quality assurance programs."

3.1 Does the proposed project address this element? (Required – Yes or No)

3.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

3.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

3.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

3.5 Estimated budget for this element: (Required only if proposal addresses this element)

3.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 4 – EFFECTIVE EMPLOYEE TRAINING

"Participation by operators, excavators, and other stakeholders in the development and implementation of effective employee training programs to ensure that operators, the one call center, the enforcing agency, and the excavators have partnered to design and implement training for the employees of operators, excavators, and locators."

4.1 Does the proposed project address this element? (Required – Yes or No)

4.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

4.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

4.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

4.5 Estimated budget for this element: (Required only if proposal addresses this element)

4.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 5 – PUBLIC EDUCATION

"A process for fostering and ensuring active participation by all stakeholders in public education for damage prevention activities."

5.1 Does the proposed project address this element? (Required – Yes or No)

5.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

5.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

5.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

5.5 Estimated budget for this element: (Required only if proposal addresses this element)

5.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 6 – DISPUTE RESOLUTION

"A process for resolving disputes that defines the State authority's role as a partner and facilitator to resolve issues."

6.1 Does the proposed project address this element? (Required – Yes or No)

6.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

6.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

6.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

6.5 Estimated budget for this element: (Required only if proposal addresses this element)

6.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 7 - ENFORCEMENT

"Enforcement of State damage prevention laws and regulations for all aspects of the damage prevention process, including public education, and the use of civil penalties for violations assessable by the appropriate State authority."

7.1 Does the proposed project address this element? (Required – Yes or No)

7.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

7.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

7.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

7.5 Estimated budget for this element: (Required only if proposal addresses this element)

7.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 8 - TECHNOLOGY

"A process for fostering and promoting the use, by all appropriate stakeholders, of improving technologies that may enhance communications, underground pipeline locating capability, and gathering and analyzing information about the accuracy and effectiveness of locating programs."

8.1 Does the proposed project address this element? (Required – Yes or No)

8.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

8.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

8.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

8.5 Estimated budget for this element: (Required only if proposal addresses this element)

8.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

ELEMENT 9 – DAMAGE PREVENTION PROGRAM REVIEW

"A process for review and analysis of the effectiveness of each program element, including a means for implementing improvements identified by such program reviews."

9.1 Does the proposed project address this element? (Required – Yes or No)

9.2 Describe any existing state-wide initiatives that support this element: (Required) type or insert text here

9.3 Is this project in a Qualified Opportunity zone? (Required if proposal addresses this element – Yes or No)

9.4 Describe how the proposed project will enhance or continue implementation of this element. If you received funding in previous years for a project that is ongoing and are requesting grant funding for the continuation of that project, provide a summary of accomplishments and tasks completed during the previous grant period. The information provided should include measurable results and deliverables, and include any information about tasks that were not completed or other challenges encountered during the grant period: (Required only if proposal addresses this element)

9.5 Estimated budget for this element: (Required only if proposal addresses this element)

9.6 Budget Description – Provide as detailed a description as possible of each of the “a” through “k” items budgeted above: (Required only if proposal addresses this element) Note:

· If you are purchasing items/supplies/other, then name what those things are, how many, and how much each item costs.

· If your budget estimate includes indirect costs, please attach a copy of your approved indirect cost rate agreement along with your proposal. If your entity does not have an approved indirect cost rate agreement, please include a statement to that effect in your budget request (per the de minimis cost rate in 2 CFR Part 200).

· If your budget includes personnel costs, please include a complete breakdown, including personnel title/position, hourly rate, and the number of hours expected to be spent by each personnel on the proposed project.

· If your proposal includes travel costs, please include adequate details on how the cost has been calculated including travel fare, hotel costs, per diem for each anticipated travel excursion, etc.

· If your proposal includes equipment costs, please include adequate details on how the cost has been calculated, including information on each specific equipment piece(s) required and their individual costs.

Legislative/Regulatory Actions

Provide a description of any legislative or regulatory actions (including legislative/regulatory studies) taken by the State within the past five years pertaining to damage prevention program improvement, even if those actions were not completely successful.

type or insert text here

Add up each element budget and insert the total for each category below

DIRECT COSTS

Personnel ..............................................................................................................................$ Fringe Benefits .....................................................................................................................$ Travel ...................................................................................................................................$ Equipment ............................................................................................................................$ Supplies ................................................................................................................................$ Contractual ...........................................................................................................................$ Other .....................................................................................................................................$ Total Direct ..........................................................................................................................$

INDIRECT COSTS

Indirect Charges ....................................................................................................................$

TOTAL ESTIMATED COSTS……………………………………………………………$